IMPROVING AND TEACHING POPULATION HEALTH Taking a look at teaching methods and materials July webinar AAMC / CDC / Duke collaboration

J. Lloyd Michener, MD Professor and Chair Department of Community and Family Medicine Director, Duke Center for Community Research Mina Silberberg, Ph.D. Associate Professor Vice-Chief for Research and Evaluation Division of Community Health Gwen Murphy, RD, MS, PhD Assistant Consulting Professor Division of Community Health Department of Community and Family Medicine

Population Health: the health outcomes of a group of individuals, including the distribution of such outcomes within the group. Source: Kindig D, Stoddart G. What is Population Health? Am J of Public Health. 2003; 93(3): The Goal: “from Health Care to Health”

How do we teach clinicians to collaborate in population health improvement? not training clinicians to be public health professionals, but to collaborate with public health and other sectors from their unique vantage point and strengths sometimes clinicians will take the lead, but not always

Focus today: Sample training materials and methods Population Health Competency Map Practical Playbook iCollaborative Population Health Collection Duke Family Medicine PHIT curriculum

The Population Health Competency Map Kaprielian VS et al. A Competency Map Approach to Education for Population Health. Academic Medicine (5): PMID:

The Population Health Competency Map Training Levels: 1. Foundational — Basic awareness of the principles and appreciation for their impact and importance in community health. 2. Applied — An intermediate level of learning, enabling skilled participation in community-engaged population health activities. 3. Proficient — Advanced learners who achieve competence for independent practice or leadership of the design and implementation of community-engaged health improvement activities. Competencies Public Health Community Engagement Critical Thinking Team Skills

Training levelsBasicIntermediateAdvanced Learner types All students & residents Primary care residents CFM faculty Population health fellows & faculty CH faculty Competency Discuss potential population-based interventions to improve health Identify appropriate preventive strategies for a population, based upon literature, data assessment and stakeholder input  Develop and implement population-based prevention strategies in collaboration with community partners

The Practical Playbook for the Integration of Public Health and Primary Care

What is integration? The Institute of Medicine defines integration as ‘the linkage of programs and activities to promote overall efficiency and effectiveness and to achieve gains in population health.’  Principles of Integration:  Shared goal of population health  Aligned leadership  Community engagement  Sustainability  Collaborative use of data

What is the Practical Playbook? Practical guidance to support the application of integration principles to practice

Practical Playbook Overview

3. Share

The AAMC MedEdPORTAL iCollaborative

Population Health Improvement Teamwork (PHIT) An evolving curriculum of Duke Family Medicine For residents (4/year) And faculty

DomainPHIT Year 1 (PGY1)PHIT Year 2 (PGY2)PHIT Year 3 (PGY3) Population Health- Non-Specific, i.e., covers multiple domains Introduction to Pop. Health. Lead: Michener Pop. Health Workshop. Lead: Martinez-Bianchi A Real-Life QI Experience. Lead: Hull Population Health Core Course (2 nd, 4 th, and 5 th Tuesdays). Lead: Silberberg. Advanced Population Health (12 sessions (1/month)). Lead: Murphy Facilitation of one core course discussion session. Lead: Silberberg All three years: Population Health Workshop with Residency Applicants. Lead: Martinez-Bianchi. Population Health Management Rotation (includes community health rotation with informatics component). Lead: Shahsahebi Attend Partnership for a Healthy Durham meetings. Lead: Martinez-Bianchi Balint Group. Lead: Kingsolver. Population Health Projects. Leads: Silberberg and Shahsahebi Presentation: The Durham Community Health Needs Assessment (Erika Samoff). Lead: Silberberg

Domain PHIT Year 1 (PGY1) PHIT Year 2 (PGY2)PHIT Year 3 (PGY3) Population Health Domain I: Public Health Public Health Essential Function web- based modules with one follow- up discussion. Lead: Murphy Population Health Domain II: Community Engagement Site visits (e.g., CAARE, Lincoln, Public Health Dept.). Lead: Tran Community health assessment and presentation. Lead: Tran. Leading a community health education session. Lead: Tran Attending a PAC meeting. Lead: Ragsdale Rotation in community clinic. Lead: Martinez-Bianchi Rotation in community clinic. Lead: Martinez- Bianchi All three years: Community Health Engagement Day. Lead: Martinez-Bianchi Sometime over the three years: Involvement with community health education training. Lead: Martinez-Bianchi

Domain PHIT Year 1 (PGY1) PHIT Year 2 (PGY2)PHIT Year 3 (PGY3) Population Health Domain III: Critical Thinking (See RCD below) I-3 Quality Thread Webinar. Lead: Ramer All three years: Journal club. Lead: Ostbye Population Health Domain IV: Leadership/Team Skills (Lead: Ragsdale) Resident as Clinical Director I -- quality improvement and informatics, assessment of leadership skills/training plan, time management, professionalism. Lead: Ragsdale Resident as Clinic Director II -- team development /group facilitation, organizational behavior and culture, collaboration in large systems, health policy. Lead: Ragsdale. Resident as Clinic Director III -- assessment of remaining leadership training needs and corresponding plan, business of medicine. Lead: Ragsdale All three years: Workshops on leadership, communications, and conflict management. Lead: Kingsolver

During the course of the three years, the resident must: 1.Play a lead role in at least one effort that involves two or more rapid CQI 2.Design an evaluation plan, collect data, analyze data, or write up evaluation results. 3.Collaborate with non-clinical entities on a community health initiative. Additional requirements 1.Document and disseminate 2.Use appropriate tools 3.Formal mentor 4.Approved workplan Resident Population Health Project Requirements

Population Health Curriculum evaluation methods Discussion participation Project completion Final assessment – just alpha-tested Post-graduation activity Real test – health improvement in home communities

Recent/ongoing developments PHIT, not PHIL Inclusion of population health management rotation Changes to project to enhance community engagement, alignment with ongoing work of clinic Testing and revising of final assessment Development of alumnae survey questions’ Increased integration among PHIT components and between PHIT, larger curriculum, and clinical practice

Milestones webinar schedule June 3 rd Tuesday 2:30pm EST repeated June 19 th Thursday 3:30pm EST July 1 st Tuesday 10am EST repeatedJuly 15 th Tuesday 9am EST August 5 th Tuesday 9am EST repeatedAugust 12 th Tuesday 9am EST September 9 th Tuesday 10am EST repeatedSeptember 16 th Tuesday 3pm EST October 8 th Wednesday 3pm EST repeatedOctober 14 th Tuesday 9am EST

Next Steps Anybody willing to volunteer today to make an institutional presentation? Sharing of alumnae survey questions and other evaluation tools…